Maire Mathilde, Debled Marc, Petit Adeline, Fournier Marion, Macgrogan Gaëtan, Quenel-Thueux Nathalie, Charitansky Hélène, Mathoulin-Pelissier Simone, Bonnefoi Hervé, Tunon de Lara Christine
Univ. Bordeaux, 146 Rue Léo Saignat, 33000, Bordeaux, France; Department of Surgery Institut Bergonié, 229 Cours de L'Argonne, 33076, Bordeaux, France.
Department of Oncology, Institut Bergonié, 229 Cours de L'Argonne, 33076, Bordeaux, France.
Eur J Surg Oncol. 2022 Aug;48(8):1699-1705. doi: 10.1016/j.ejso.2022.04.022. Epub 2022 Apr 29.
The reverse sequence of neoadjuvant chemotherapy, preoperative radiotherapy, mastectomy then immediate breast reconstruction is currently proposed for selected patients with locally advanced breast cancer. Few studies have compared it to the standard sequence of neoadjuvant chemotherapy, mastectomy and radiotherapy with or without differed reconstruction. Our study compares overall (OS) and recurrence-free (RFS) survivals of breast cancer patients treated with reverse sequence compared to the standard technique.
In this retrospective, single center study at a Comprehensive Cancer Center in France, patients were included if: female, age <65y, had received neoadjuvant chemotherapy, mastectomy and radiotherapy, and were M0. Outcomes for patients treated by reverse sequence (RS) are compared to those for patients treated by standard sequence (ST). Data was collected from medical records.
From January 2009 to April 2018, 222 eligible patients were treated, 46 by RS and 176 by ST. Mean follow-up was 61.7 months. Five-year OS and RFS did not differ between groups. 5-yr OS: 88.4% 95%CI [74.1-95.0] for RS and 81.5% 95%CI [74.0-87.0] for ST (P = 0.4412); 5-yr RFS: 78.3% 95%CI [61.9-88.3] for RS and 70.1% 95%CI [62.2-76.7] for ST (P = 0.3003). Overall treatment time was significantly shorter in the RS group, and the rate of severe surgical complications did not differ between groups.
For locally advanced breast cancer patients with an indication for radiation therapy the reverse sequence offers similar safety and efficacy results as the standard treatment while allowing immediate breast reconstruction. However, careful patient selection is necessary, particularly with regard to preoperative lymph node invasion.
目前，对于部分局部晚期乳腺癌患者，建议采用新辅助化疗、术前放疗、乳房切除然后即刻乳房重建的反向顺序治疗方案。很少有研究将其与新辅助化疗、乳房切除以及放疗（无论是否进行延迟重建）的标准顺序治疗方案进行比较。我们的研究比较了采用反向顺序治疗方案与标准技术治疗的乳腺癌患者的总生存期（OS）和无复发生存期（RFS）。
在法国一家综合癌症中心进行的这项回顾性单中心研究中，符合以下条件的患者被纳入研究：女性，年龄<65岁，接受过新辅助化疗、乳房切除和放疗，且为M0期。将采用反向顺序（RS）治疗的患者的结局与采用标准顺序（ST）治疗的患者的结局进行比较。数据从医疗记录中收集。
2009年1月至2018年4月，共治疗了222例符合条件的患者，其中46例采用RS治疗，176例采用ST治疗。平均随访时间为61.7个月。两组之间的5年总生存期和无复发生存期无差异。5年总生存期：RS组为88.4%，95%置信区间[74.1 - 95.0]；ST组为81.5%，95%置信区间[74.0 - 87.0]（P = 0.4412）；5年无复发生存期：RS组为78.3%，95%置信区间[61.9 - 88.3]；ST组为70.1%，95%置信区间[62.2 - 76.7]（P = 0.3003）。RS组的总体治疗时间明显更短，两组之间严重手术并发症的发生率无差异。
对于有放疗指征的局部晚期乳腺癌患者，反向顺序治疗方案与标准治疗方案具有相似的安全性和疗效结果，同时允许即刻乳房重建。然而，需要仔细选择患者，尤其是在术前淋巴结侵犯方面。
